RT Journal Article
SR Electronic
T1 Covert Medication in Psychiatric Emergencies: Is It Ever Ethically Permissible?
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 239
OP 245
VO 40
IS 2
A1 Erick K. Hung
A1 Dale E. McNiel
A1 Renée L. Binder
YR 2012
UL http://jaapl.org/content/40/2/239.abstract
AB Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice.